Techniques & Technologies

Moral treatment

The Retreat, York, c. 1792.

Moral treatment was the cornerstone of mental health care in the 1800s. The idea it rested on was humane but paternalistic: moral treatment’s advocates believed that an asylum patient had a better chance of recovery if treated like a child rather than an animal. It was introduced by Quaker asylum director William Tuke at the end of the 1700s. Moral treatment rejected orthodox medical treatments used in asylums of the time, which mostly involved blood-letting, purging and physical restraints such as chains and manacles. Tuke’s revolutionary idea was to make his asylum a strict, well-run household. Patients were expected to dine at the table, make polite conversation over tea, consider the consequences of their actions, and clean and garden. The asylum director established comprehensive rules and constant surveillance, enforced by simple rewards and punishments. Sanity was to be restored through self-discipline.

As asylum construction ballooned in the 1800s, moral treatment and medical treatment came together. French asylum physician Pinel championed Tuke’s work. Generations of asylum directors, inspired by Pinel, became the strict but benevolent father. But critics in the early 1900s argued moral treatment did not cure patients. They said it made patients dependent on the doctor and the asylum. Later in the 1900s, historians argued moral treatment replaced the actual chains of early asylums with invisible chains, making them even harder to escape from.